Provider Demographics
NPI:1740796655
Name:BOREL, ALLISON (LPC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:BOREL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 E 70TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5332
Mailing Address - Country:US
Mailing Address - Phone:318-751-9098
Mailing Address - Fax:318-751-9099
Practice Address - Street 1:2020 E 70TH ST STE 201
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:318-751-9098
Practice Address - Fax:318-751-9099
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014193101YP2500X
LA7285101YP2500X
101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7285OtherLPC